Prognostic stratification in resected pulmonary neuroendocrine carcinomas: Analysis of the French database EPITHOR.

OBJECTIVE

Pulmonary neuroendocrine carcinomas, encompassing large-cell (LCNEC) and small-cell lung carcinoma (SCLC), are aggressive tumors in which surgical resection is indicated with caution. Aim of the study was to perform a large survival analysis, identify prognostic factors and refine patient stratification using a data-driven clustering approach.

METHODS

We extracted all patients from the exhaustive EPITHOR national database who underwent resection of pulmonary neuroendocrine carcinomas between 2002 and 2023. Log-Rank tests and conventional Cox-regressions were performed to assess impact of variables on survival, including cluster label based on non-categorical preoperative characteristics computed by the K-means method.

RESULTS

1936 neuroendocrine carcinomas were identified, 1229 LCNEC (63.5%) and 707 SCLC (36.5%). Mean age at surgery was 63.8 years, with 68.8% men. Anatomic pulmonary resection was performed in 97.1% of cases, and 90-days morbidity-mortality rates were 33.8% and 8.3%, respectively. Five-year OS reached 52.9% for LCNEC and 45.5% for SCLC. Three different clusters were calculated, in which distribution of pTNM stages and histological type were not significantly different. Log-Rank analyses revealed that tobacco consumption, sex, TNM stage, histological type, and cluster label were statistically associated with OS. The prognostic impact of cluster remained significant across most subgroups, including sex and pTNM stage. Cox analyses confirmed sex, pTNM, histological type, and cluster as independent predictors, with clustering showing stronger prognostic value than histological type.

CONCLUSION

s: Resection of pulmonary neuroendocrine carcinomas yields encouraging outcomes in highly selected patients. Further TNM-stage and histology, prognostic stratification could be improved by a clustering approach based on simple preoperative characteristics.